De Quervain's disease R6 | Nerve Surgery

This disabling tendinopathy is a degenerative condition affecting two tendons (abductor pollicus longus andextensor pollicus brevis) on the thumb side of the forearm. It is seen predominantly in females during child bearingage as well as pre-menopausal women.

The condition basically affects the synovial sheath of these tendons. As the tendons become thicker and swollen,the space in the tunnel that keeps them close to the bone (first dorsal extensor compartment) becomes smaller(stenosis). There is less space for the tendons to glide freely, and this aggravates the pain and symptoms.

Symptoms

Pain is felt over a very specific place on the radial (thumb) side of the wrist and certain movements like picking achild up under his arms, aggravates the pain. Often wringing and pinching causes pain.

Finkelstein’s test (where the thumb is passively flexed and the wrist moved into ulnar deviation) causes significantsharp pain over the radial side of the wrist.

Pain is felt over a very specific place on the radial (thumb) side of the wrist.

Treatment

Postion of Pain

Finkelstein’s test

Treatment comprises avoidance of aggravating motions, splinting (poor response generally) and steroid injections.Steroid injections tend to work well in about 60% of people. These injections, especially multiple ones, may havethe side effects of discolouration of the skin and fat atrophy of the skin at the site of injection.

Surgical treatment is an option if conservative treatment fails and is based on releasing the sheath of the firstdorsal compartment to create space for free gliding of the tendons.

The operation is usually performed under a general anaesthetic.A 2-3 cm incision is made on the thumb side of the wrist..The superficial branch of the radial nerve is identified and protected.The roof of the first dorsal compartment is released.The tendons are identified and freed from surrounding tissue.The membranes around the tendons (synovial sheaths) are excised to create space and ensure better gliding ofthe tendons.The skin is closed with subcutaneous monocryl sutures.A thumb spica cast is fitted.

Steroid injections tend to work well in about 60% of people.

Expectations after the Operation

The wound has to be kept dry and the cast and dressings should not be be removed for 10-14 days.Once the cast is removed with the first wound check, the wrist and thumb can be mobilized.It can take up to 6 months for the thumb and wrist to feel strong again.There is a 2-5% recurrence rate.

The Surgical Incision for De Quervains release

Potential Complications

1. The superficial branch of the radial nerve can be injured during the surgery but this is exceedingly rare.2. There might be delayed wound healing or wound infection (<1.5%).

Rehabilation after the Operation

Exercises

Active Wrist Exercise

Active Thumb Exercise

Active Thumb Exercise